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THE TWINING LABORATORIES, INC. Project Alame � "�� <br /> 2527 Fresno Street, Fresno, CA 93721 <br /> Address ;t . x` <br /> (209) 288-7021 ". <br /> Date ° � 1)Page nt <br /> HiChain-of-Custodyand Analysis Request Record Mgr. Tt# j <br /> Copies To: "Y _ <br /> ---�� i'_ <br /> Report To: Apar aequesed <br /> Client Name '. F iI Lab Due Date:. <br /> Sll Tp: <br /> Address— <br /> Contact <br /> ddress Contact Name �, : <br /> �" 7RCUTINE <br /> cted Turnaround: <br /> Phone ,``1 ©RUSH VERSALS` C7RUSH REPORT" <br /> Contract/PO# Additional Fees Apply <br /> Specify Date: <br /> Viler Name � . � ,,�� p ty <br /> (Printl ©FAX# <br /> Lab Client <br /> t�# Sample ID Date/Time le Sample <br /> #/Size/Type of Comalner ti0 $ ttdltng: Loco" <br /> Each hazardous sample submitted For Water samples, please <br /> P Comments: /TiMe Location <br /> for analysis will be charged a hazard check one of the following: ' <br /> ous waste dispersal fee- Clients that 11 Drinking Water ` <br /> retrieve hazardous samples within 30 L1 Waste Water _ _ " _ <br /> days of the analytical report date will 17 Ground Water(wells) <br /> be refunded any disposal fees. <br /> 11 Surface Waterrivers,lakes) <br /> ) <br /> Relinquished By: Delivered By: <br /> Receive <br /> Signature _ r° _ Signature t- <br /> - �...- _ Sigma°-� <br /> Printed - Printed ._ <br /> Company fi Crttparty �- <br /> Company m, E .p tL r Date/Time <br /> Date/Time <br /> Date/Time - Log at ime <br /> ... gtq <br /> SHADED APEAS FOR OFFICE USE ONLY <br />